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This is the published version of a paper published in Acta Paediatrica.

Citation for the original published paper (version of record):

Fröberg, A., Lindroos, A-K., Ekblom, Ö., Nyberg, G. (2020)

Organised physical activity during leisure time is associated with more objectively

measured physical activity among Swedish adolescents.

Acta Paediatrica, 109(9): 1815-1824

https://doi.org/10.1111/apa.15187

Access to the published version may require subscription.

N.B. When citing this work, cite the original published paper.

This is an open access article under the terms of the Creative Commons

Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium,

provided the original work is properly cited and is not used for commercial purposes.

Permanent link to this version:

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Acta Paediatrica. 2020;00:1–10. wileyonlinelibrary.com/journal/apa

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1 | INTRODUCTION

Convincing evidence shows associations between physical activity (PA) and health benefits among children and adolescents.1 Some re-searchers have also begun to acknowledge the potential negative health consequences of sedentary time.2

Despite the well-established health benefits of PA, most children and adolescents do not reach the 60 or more daily minutes of mod-erate-to-vigorous PA (MVPA) recommended by the World Health Organization.3 In a large representative sample of Swedish adoles-cents, 32% reached the PA recommendation with 43% and 23% of boys and girls, respectively.4 Studies measuring PA with objective methods Received: 27 June 2019 

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  Revised: 9 December 2019 

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  Accepted: 20 January 2020

DOI: 10.1111/apa.15187

R E G U L A R A R T I C L E

Organised physical activity during leisure time is associated

with more objectively measured physical activity among

Swedish adolescents

Andreas Fröberg

1

 | Anna-Karin Lindroos

2,3

 | Örjan Ekblom

4

 | Gisela Nyberg

4,5

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

© 2020 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.

Abbreviations: MVPA, moderate-to-vigorous physical activity; PA, physical activity. 1Department of Food and Nutrition and

Sport Science, University of Gothenburg, Gothenburg, Sweden

2Swedish Food Agency, Uppsala, Sweden 3Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

4The Swedish School of Sport and Health Sciences, Stockholm, Sweden

5Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

Correspondence

Andreas Fröberg, Department of Food and Nutrition and Sport Science, University of Gothenburg. Pedagogen, Hus C, Läroverksgatan 5, PO Box 300, SE-405 30, Gothenburg, Sweden.

Email: andreas.froberg@gu.se

Funding information

This study was funded by the Swedish Research Council for Sport Science.

Abstract

Aim: The aim of this study was to investigate associations between participation

in organised physical activity (PA), such as sport and exercise during leisure time, and objectively measured PA and sedentary time in a large representative sample of Swedish adolescents.

Methods: This study was part of the school-based cross-sectional Swedish national

dietary survey Riksmaten Adolescents 2016-17. Data from 3477 adolescents aged 11-12, 14-15 and 17-18 years were used in the analyses. Participation in organised PA and parental education were reported in questionnaires. PA and sedentary time were objectively measured through accelerometry during seven consecutive days.

Results: Adolescents who participated in organised PA had significantly higher total

PA (14%, P < .001), more time spent on moderate-to-vigorous PA (MVPA) (8 minutes,

P < .001) and had less sedentary time (15 minutes, P < .001). Those who participated

in organised PA were more likely to reach recommended PA levels. Total PA and MVPA did not differ by parental education among those who participated in organ-ised PA.

Conclusion: Adolescents who participated in organised PA were more physically

ac-tive, less sedentary and more likely to reach PA recommendations than those who did not.

K E Y W O R D S

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such as accelerometers also suggest that children and adolescents spend most waking hours sedentary.5 In addition, PA decreases and sedentary time increases throughout childhood and adolescence3 and the decrease in PA might be more profound during adolescent years.6 For example, a 9-year follow-up study involving Swedish participants showed that MVPA decreased with approximately 30 minutes per day from childhood to adolescence.7 Also, a previous study from Sweden showed that boys are more physically active than girls.8

Clearly, effective PA interventions for children and adolescents are urgently needed. Systematic reviews and meta-analyses of PA interventions published during the last decade generally show small to negligible effects on PA among children and adolescents.9-12 Many children and adolescents participate in organised PA such as sport and exercise during leisure time. According to results from the 2016 Report Card on Physical Activity for Children and Youth, ap-proximately 75% of Swedish adolescents aged 11-15 participate in organised sport twice or more weekly.13 Organised PA is therefore often regarded as a promising intervention strategy to increase PA.14 Recent systematic reviews also demonstrate more MVPA among children and adolescents who participate in sports and exercise than among those who do not.15,16 Most of the reviewed studies assessed PA by self-report measures15,16 but some studies using objective methods such as accelerometry have also reported positive associa-tions between participation in sport and exercise and PA.17-19

However, less is known about how organised PA is associated with sedentary time. For example, Marques et al found that children and adolescents who participated in organised sports spent more time in objectively measured moderate PA, vigorous PA and MVPA than those who did not, yet no difference was observed for sedentary time.19

In Sweden, no nationally representative study has yet investi-gated the associations between participation in organised PA and objectively measured PA and sedentary time among adolescents. Such studies are important because they might contribute with background information when developing intervention strate-gies to increase PA among adolescents, or at least counteract the age-related decrease commonly observed during adolescent years. Therefore, this study aimed to investigate associations between par-ticipation in organised PA, such as sport and exercise during leisure time, and objectively measured PA and sedentary time in a large rep-resentative sample of Swedish adolescents.

2 | METHODS

This study was part of the national, cross-sectional, dietary survey Riksmaten Adolescents 2016-17 conducted by the Swedish Food Agency in Sweden between September 2016 and May 2017. School classes in grades 5 (11-12 years), 8 (14-15 years) and 11 (17-18 years) were recruited to be representative of these grades in Sweden, and the students in the selected classes were invited to take part. In ad-dition to information on dietary intake, which was the main focus of the survey, information on organised physical activity was col-lected through web questionnaires. PA and sedentary time were

also objectively measured. Trained field staff from the Swedish Food Agency visited during school hours to inform the students about the study and the web questionnaires. They also distributed accelerom-eters and measured body height and body weight. The study design, methods and participation are described in detail elsewhere.20

2.1 | Recruitment of participants

Statistics Sweden selected schools based on type of municipality, school organisation (public or independent) and geographical lo-cation. In total, 619 schools, approximately 200 from each school grade, were invited to take part via e-mails addressed to the principal.

A total of 131 schools agreed to take part, and one or two classes per school were selected to participate in the survey. The schools se-lected 1-2 classes in a given school grade, and all students (n = 5145) in these classes were invited to participate. Exclusion criteria were not being able to read and write Swedish. A total of 3477 students participated in at least one part of the survey. The participants were overall considered to be representative for the population with re-gard to socio-economic background and school (public or indepen-dent), and schools were distributed throughout Sweden with all types of municipalities represented.20

The Regional Ethical Review Board in Uppsala approved the study (No. 2015/190). Before study start, information letters were sent to all students and their parents. From schools with biological sampling, written consent was required from all participants and both parents of adolescents younger than 16 years. In schools with-out biological sampling, opt-with-out consents were used and approved by the ethics committee.

2.2 | Data collection

The participants were asked whether they were active in any or-ganisation or club, such as soccer, swimming, dance and scouts

Key notes

• In Sweden, no nationally representative study has in-vestigated the associations between participation in or-ganised physical activity (PA), such as sport and exercise during leisure time, and objectively measured PA among adolescents

• Adolescents who participated in organised PA were more physically active, less sedentary and more likely to reach PA recommendations than those who did not. • The study results might contribute with background

in-formation when developing interventions to increase PA among adolescents.

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FRÖBERG Etal.

with the responses being yes or no. A follow-up question was which organisation or club they participate in and what kinds of activities that were included. This question had an open response alternative, and participants could provide multiple responses. These responses were manually reviewed, and activities involv-ing PA such as soccer, floorball, dance and martial arts were con-sidered as organised PA, thus excluding activities such as playing musical instruments and theatre. To assess frequency of par-ticipation in organised PA, the participants provided information about how many times per week they participate in their activi-ties. This question was answered using the categories once per week, twice per week, three times per week, four times per week, or five or more times per week.

Accelerometers from ActiGraph models GT3X and GT3X+ (ActiGraph LLC) were used to objectively measure PA and seden-tary time. The Swedish Food Agency field staff distributed the ac-celerometers during school visits. The participants were instructed to wear the accelerometer on the right hip with an elastic belt for seven consecutive days including five weekdays and two weekend days except while asleep and during water-based activities such as swimming and showering. The class teacher collected the monitors after 7 days and sent them back to the Swedish Food Agency in a pre-paid envelope.

The accelerometers were set to sample at 30 Hz and aggre-gate the raw data into 5-second epochs. The data were processed using ActiLife version 6.13.3. The non-wear time filter was set to remove all sequences of at least 60 consecutive minutes of zero counts (no tolerance), and at least 500 minutes of wear time was required for a day to be considered valid. A time filter was set between 06:00 and 22:59 for those aged 11-12 and 14-15 and 06:00 and 23:59 for those aged 17-18. Participants with at least

three valid days (two weekdays and one weekend day) were in-cluded in the analysis. Total PA was estimated by using the sum of the vertical axis (v) activity counts divided by recorded min-utes (counts per minute). Cut-points were used to estimate MVPA (≥2296 counts per minute) and sedentary time (≤100 counts per minute).21,22

Parents' educational attainment was reported in a web question-naire for the parents. The highest level of education attained by ei-ther of the parents was used, and the responses were dichotomised into low parental education (≤12 years of schooling) and high paren-tal education (>12 years of schooling).

The participants reported which country they were born in. Based on this information, country of birth was dichotomised into Sweden or outside Sweden.

Information on municipality was based on the participants' schools. The municipalities were categorised into one of five groups based on the Swedish municipality classification 2011. The first three groups were metropolitan municipalities, suburbs surrounding metropolitan areas, and larger cities and surrounding suburbs. These three groups were categorised as urban areas. The other two were densely populated municipalities and other municipalities, such as commuter municipalities, tourism and travel industry municipalities, manufacturing municipalities, sparsely populated municipalities and municipalities in sparsely populated regions. These two groups were categorised as rural areas.

Trained staff from the Swedish Food Agency measured body height and weight by standardised methods in schools. Body height (nearest 0.1 cm) and weight (nearest 0.1 kg) were mea-sured by SECA 213 portable stadiometers (SECA Weighing and Measuring Systems) and SECA 862 or 899 digital weighing scales (SECA Weighing and Measuring Systems), respectively. Body mass

F I G U R E 1   Types of organised PA reported by the participants presented as frequency in descending order. The category other includes organised PA such as badminton, bandy, baseball, cycling, figure skating, golf and table tennis

0% 5% 10% 15% 20% 25% 30% 0 100 200 300 400 500 600 700 800 Frequenc y (% ) Frequency (n )

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index was calculated (kg/m2) and weight status was defined ac-cording to recommendations from the International Obesity Task Force.23

2.3 | Statistics

All data analyses were performed using IBM SPSS Statistics for Windows, version 24.0. (IBM Corp). Descriptive statistics are pre-sented as means, standard deviations (SD) and proportions. The chi-square test was used to analyse categorical data. Analyses of co-variance were used to investigate differences in total PA, MVPA and sedentary time between those who participated in organised PA and those who did not by total sample, sex and age (presented as mean and standard error). Among those who participated in organised PA, analyses of covariance were also used to investigate whether total PA and MVPA differed between those from low and high pa-rental education groups. Further, binary logistic regression was used to investigate the likelihood of reaching the PA recommendations of a daily mean of 60 minutes or more of MVPA among those who participated in organised PA. In these analyses, those who did not participate in organised PA were set as reference. All analyses were adjusted for sex and age when not stratified, and parental educa-tion, country of birth and type of municipality. The level of statistical significance was set at P < .05.

3 | RESULTS

Of the 3477 adolescents who participated in Riksmaten Adolescents 2016-17, a total of 3337 (96%) responded to the ques-tion regarding organised PA. Of these, 2209 (66%) reported par-ticipating in some type of organised PA and 1128 (34%) reported that they did not. Soccer (27%) was the most frequently reported category of organised PA, followed by the category other, includ-ing activities such as badminton, bandy, baseball, cyclinclud-ing, figure skating, golf and table tennis (10%), and floorball (9%), dance (8%) and martial arts (6%) (Figure 1). Boys, younger participants, those who had parents with a higher education and those born in Sweden were more likely to report participating in organised PA than girls (P = .04), older participants (P < .001), those who had parents with a lower education (P < .001) and those born outside Sweden (P < .001). No significant difference was observed for type of municipality (P = .18).

The participant characteristics are shown in Table 1. In the total sample, the prevalence of overweight and obesity was 21%. The cor-responding figures for those who participated in organised PA or not were 19% and 27%, respectively (P < .001).

Of the 3302 adolescents who wore the accelerometers, 2419 (73%) had at least three days of valid registrations. More girls and younger participants wore the accelerometers for at least 3 days than boys and older participants (both P < .001). Those who had parents with a higher education were those born in Sweden, and

T A B LE 1  D es cr ip tiv e c ha ra ct er is tic s o f t he p ar tic ip an ts i n t he t ot al s am pl e a nd s tr at ifi ed b y b oy s a nd g irl s a nd a ge g ro up A ll 11 -1 2 y 14 -1 5 y 17 -1 8 y To ta l B oy s G irl s To ta l B oy s G irl s To ta l B oy s G irl s To ta l B oy s G irl s n = 34 77 n = 16 35 n = 18 42 n = 12 17 n = 59 5 n = 62 2 n = 11 98 n = 57 3 n = 62 5 n = 10 62 n = 46 7 n = 59 5 A ge ( y) ( M ea n ± SD ) ( n = 34 75 ) 14 .4 (2 .6 ) 14 .4 (2 .5 ) 14 .5 (2 .6 ) 11 .5 (0 .4 ) 11 .5 (0 .4 ) 11 .5 (0 .4 ) 14 .5 (0 .4 ) 14 .5 (0 .4 ) 14 .5 (0 .4 ) 17 .7 (0 .7 ) 17. 8 ( 0. 7) 17. 7 ( 0. 6) H ig h p ar en ta l e du ca tio n ( % ) ( n = 30 47 ) 61 60 62 62 60 64 63 60 65 57 58 56 C ou nt ry o f b ir th , S w ed en ( % ) ( n = 34 38 ) 88 87 89 90 89 91 87 85 88 87 86 88 Ty pe o f m un ic ip al ity , u rb an ( % ) ( n = 34 77 ) 68 71 66 71 73 68 75 72 77 58 65 53 B M I c ate go rie s a (n = 3 44 3) U nd er w ei gh t ( %) b 7 6 7 8 7 9 7 6 7 5 5 5 N or mal w ei gh t ( % ) b 72 72 72 70 71 68 75 75 76 71 68 72 O ve rw ei gh t (% ) b 17 17 17 18 18 18 15 15 15 19 20 18 O be se ( % ) b 4 5 4 4 4 4 4 5 3 6 7 4 A bb re vi at io n: B M I, b od y m as s i nd ex . a D ef in ed a cc or di ng t o I O TF . b To ta ls m ay n ot a dd u p d ue t o r ou nd in g.

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FRÖBERG Etal.

those who participated in organised PA were also more likely to wear the accelerometers for at least three days (all P < .001). No significant difference was observed for type of municipality (P = .07).

In total, 2146 adolescents both responded to the question re-garding organised PA, had at least three days of accelerometer data and provided information on the variables controlled for. Of these, 1478 participated in organised PA (69%) and 668 (31%) did not. Those who participated in organised PA reported the following fre-quency per week: 16% reported once, 22% said twice, 24% three times, 20% four times and 19% five times or more.

The mean (SD) accelerometer wear time was 809 (76) and 810 (77) minutes per day among those who participated in organised PA and those who did not, respectively (P = .98).

3.1 | Physical activity and sedentary time

Figure 2 shows adjusted analyses for total PA (counts per minutes) from Monday to Sunday among those who did or did not participate in organised PA (differences between the two groups P < .001 all days). Those who participated in organised PA had higher weekly average total PA, spent more time in MVPA and had less sedentary time than those who did not (Table 2). For example, those who par-ticipated in organised PA had approximately eight more minutes of MVPA and 15 minutes less sedentary time per day.

Total PA, MVPA and sedentary time all differed (P < .001) depend-ing on weekly frequency of participation in organised PA. As shown in Figure 3, total PA and MVPA increased, whereas sedentary time decreased, with higher frequency of participation in organised PA.

In the total sample, 37% of those who participated in organised PA reached the PA recommendations versus 20% of those who did not (P < .001) (Table 2). Those who participated in organised PA were 2.2 (95% CI: 1.8-2.8) times more likely to reach the PA recommenda-tions. Results were similar for boys and girls (Table 3).

3.2 | Age group

Adjusted analyses stratified by age group revealed that those who participated in organised PA had more total PA and MVPA relative to those who did not. These results were observed across all age groups. Further stratification by sex within each age group gave similar results, except for boys aged 17-18. Generally, weaker associations were found for sedentary time. Sedentary time did not differ between those who participated in organised PA and those who did not among boys and girls aged 11-12 and girls aged 14-15, and boys and girls aged 17-18 (Table 2).

More of those who participated in organised PA reached the PA recommendations except for boys aged 14-15 and 17-18 years (Table 2). Those aged 11-12, 14-15 and 17-18 years who participated in organised PA were 2.6 (95% CI: 1.7-3.8), 2.8 (95% CI: 1.8-4.5) and 1.9 (95% CI: 1.2-2.7) times more likely to reach the PA recommenda-tions, respectively (Table 3).

3.3 | Parental education

Total PA and MVPA did not differ by parental education among those who participated in organised PA (both P > .05). Figure 4 shows total F I G U R E 2   Total PA each day of the

week among those who participated in organised PA and those who did not. Adjusted for sex, age group, parental education, country of birth and type of municipality (presented as mean with 95% CI) 300 350 400 450 500

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Total PA (counts per minute

s)

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TA B L E 2   Total PA, MVPA and sedentary time among those who participated in organised PA and those who did not in the total sample and stratified by boys and girls and age group

All Participated in organised PA Total P Boys P Girls P

Yes No Yes No Yes No

Weekly average n = 1478 n = 668 n = 627 n = 258 n = 851 n = 410

Total PA, CPM/day (Mean (SE)) 438 (4.0) 381 (6.1) <.001 465 (6.6) 417 (10.4) <.001 419 (5.0) 356 (7.4) <.001

MVPA, min/day (Mean (SE)) 55 (0.5) 47 (0.8) <.001 59 (0.9) 53 (1.4) <.001 52 (0.6) 43 (0.9) <.001

Sedentary time, min/day (Mean

(SE)) 616 (2.0) 631 (3.0) <.001 604 (3.1) 623 (4.9) .002 625 (2.6) 636 (3.8) .02 Reaching the PA recommendation (%) 37 20 <.001 48 32 <.001 29 13 <.001 11-12 y Participated in organised PA Total P Boys P Girls P

Yes No Yes No Yes No

Weekly average n = 669 n = 154 n = 297 n = 77 n = 372 n = 77

Total PA, CPM/day (Mean

(SE)) 513 (6.8) 451 (14.4) <.001 530 (10.1) 481 (20.1) .03 498 (9.2) 426 (20.7) .002

MVPA, min/day (Mean (SE)) 60 (0.7) 51 (1.5) <.001 66 (1.2) 57 (2.4) .002 56 (0.9) 46 (1.9) <.001

Sedentary time, min/day

(Mean (SE)) 581 (2.8) 591 (6.0) .13 578 (4.3) 584 (8.5) .52 584 (3.7) 597 (8.4) .16 Reaching the PA recommendation (%) 46 27 <.001 58 38 .001 36 15 <.001 14-15 y Participated in organised PA Total P Boys P Girls P

Yes No Yes No Yes No

Weekly average n = 523 n = 197 n = 227 n = 69 n = 296 n = 128

Total PA, CPM/day (Mean

(SE)) 405 (5.8) 334 (9.4) <.001 445 (10.2) 362 (18.5) <.001 376 (6.6) 316 (10.2) <.001

MVPA, min/day (Mean (SE)) 52 (0.8) 43 (1.3) <.001 56 (1.4) 48 (2.6) .004 48 (0.9) 40 (1.4) <.001

Sedentary time, min/day (Mean (SE)) 626 (3.2) 649 (5.2) <.001 606 (5.0) 642 (9.1) .001 641 (4.1) 655 (6.3) .07 Reaching the PA recommendation (%) 31 15 <.001 42 31 .066 22 6 <.001 17-18 y Participated in organised PA Total P Boys P Girls P

Yes No Yes No Yes No

Weekly average n = 286 n = 317 n = 103 n = 112 n = 183 n = 205

Total PA, CPM/day (Mean (SE))

379 (7.8) 327 (7.4) <.001 380 (15.0) 357 (14.4) .27 378 (8.9) 311 (8.4) <.001

MVPA, min/day (Mean (SE)) 50 (1.2) 45 (1.1) <.001 51 (2.1) 48 (2.1) .44 50 (1.4) 43 (1.3) <.001

Sedentary time, min/day (Mean (SE))

652 (4.7) 665 (4.4) .06 649 (8.3) 664 (8.0) .20 655 (5.6) 665 (5.3) .20

Reaching the PA recommendation (%)

29 20 .007 35 28 .249 26 16 .013

Note: Analyses of covariance were adjusted for sex and age group (when not stratified), parental education, country of birth and type of municipality (presented as mean with standard error).

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PA each day of the week among those who did/did not participate in organised PA and whose parents had low/high education levels.

4 | DISCUSSION

The main finding of this study was a positive association between or-ganised PA and objectively measured PA in a representative sample of Swedish adolescents. The results were similar for boys and girls across all age groups, with the exception of boys aged 17-18. Those who participated in organised PA were more likely to reach the PA recommendations than those who did not participate in organised PA. However, the results for participation in organised PA and sed-entary time were less clear.

Overall, our findings align with conclusions from previous sys-tematic reviews of studies mainly using self-reported measures of PA 15,16 as well as recent studies that have used objective methods to assess PA.17-19 For example, Hebert et al, who analysed accelerome-ter data from 1124 Danish children (mean age 8 years), reported that participation in organised sports such as soccer and handball were associated with 5-20 additional minutes of MVPA and 3-15 times increased likelihood of reaching PA recommendations.17 Another study including children and adolescents aged 10-18 years found that organised PA was associated with more MVPA and increased likelihood of reaching PA recommendations.19

Our study also showed that those who participated in organised PA five times per week or more had the highest total PA and MVPA, and the lowest sedentary time. Although we did not specifically as-sess duration per as-session of organised PA, these results align with those of a study in which Dalene et al analysed accelerometer data from Norwegian children and adolescents aged 9 and 15 years and found that those who participated in organised sports or exercise 8 hours or more per week had approximately 15-18 minutes more MVPA per day than those who reported 2 hours or less.18

Moreover, compared with non-participants, those who partici-pated in organised PA five times per week or more spent approxi-mately 15 more minutes per day in MVPA in the total sample and 8 more minutes among adolescents aged 17-18 years. In addition, the likelihood of reaching the PA recommendations doubled to qua-druple depending on sex and age group: 37% of those participating in organised sports reached the recommendations vs 20% among non-participants. Our results, although cross-sectional, might F I G U R E 3   Total PA, MVPA and sedentary time among those who did not participate in organised PA and those who did according to frequency per week in the total sample and stratified by age group. Adjusted for sex, age group (when not stratified), parental education, country of birth and type of municipality (presented as mean with 95% CI)

Total PA MVPA Sedentary time

250 300 350 400 450 500 550 600 650

Counts per minute

s Total 11-12 years 14-15 years 17-18 years 30 40 50 60 70 80 Minutes per da y Total 11-12 years 14-15 years 17-18 years 500 550 600 650 700 750 Minutes per da y Total 11-12 years 14-15 years 17-18 years

TA B L E 3   Binary logistic regression representing the likelihood of reaching the PA recommendations among those who

participated in organised PA with those who did not stratified by boys and girls and age group

Total Boys Girls

All 2.2 (1.8-2.8) 2.0 (1.4-2.8) 2.5 (1.7-3.5)

11-12 y 2.6 (1.7-3.8) 2.4 (1.4-4.1) 2.9 (1.5-5.6)

14-15 y 2.8 (1.8-4.5) 2.0 (1.1-3.7) 4.1 (1.9-8.9)

17-18 y 1.9 (1.2-2.7) 1.7 (0.9-3.2) 1.9 (1.1-3.2)

Note: Adjusted for sex and age group (when not stratified), parental education, country of birth and type of municipality (presented as odds ratio with 95% CI).

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contribute with background information when developing interven-tions to increase PA among adolescents. Besides getting more PA, children and adolescents who participate in sports appear to reap social and psychological health benefits such as social skills, self-es-teem, confidence and competence.24

Our results must also be interpreted with some caution. We lack data on how PA patterns change when adolescents begin to partic-ipate—or increases participation—in organised PA. Further, from a public health perspective, the higher prevalence of overweight and obese among non-participants, compared with participants, might not necessarily be interpreted as an effect of exercise, as the associ-ation between PA and overweight and obesity has been shown to be modest or weak.25 Rather, adolescents with overweight or obesity might experience that they do not fit in organised PA such as sports and therefore do not participate. However, previous lifestyle-based interventions including PA to prevent overweight and obesity have demonstrated some effectiveness among adolescents.26 Therefore, interventions to increase participation in organised PA among ado-lescents might be efficient, especially if clubs would be able to make the participation sustainable.

Furthermore, not all analyses showed associations between partic-ipation in organised PA and sedentary time. The associations observed for the total sample, and when stratified by boys and girls, disappeared after further stratification by age group for those aged 11-12 and 17-18 years. These results resemble those reported by Marques et al and suggest that participation in organised PA is associated with more total PA and MVPA but not necessarily less sedentary time.19

Organised PA was associated with higher total PA and more time spent in MVPA regardless of parental education level, but fewer ad-olescents from the low parental education group participated in or-ganised PA. This is an important finding since some studies indicate

that adolescents from low socio-economic status groups, such as those from families with low parental education, generally have less PA than those from high socio-economic status groups.27 This might be due to economic factors as organised PA might require financial outlay to cover, for example, sports equipment and membership fees. For exam-ple, a previous systematic review suggested that financial resources were one key barrier to participate in organised sport among children and adolescents.28 According to Martins et al, this might be specific for adolescents in low socio-economic areas.29 In line with this, lack of financial support was identified as a barrier to participate in organised PA among adolescents in a Swedish low socio-economic status area.30

4.1 | Strengths and limitations

This was the first study to investigate the association between participation in organised PA and objectively measured PA and sedentary time among adolescents using data from a nationally rep-resentative Swedish study. Major strengths included the large sam-ple size and the use of accelerometry to objectively measure PA and sedentary time.

Limitations included the cross-sectional design, which precluded conclusions about causality. This is important given that one pre-vious study has shown cross-sectional associations between par-ticipation in organised sport and objectively measured PA among children and adolescents aged nine and 15 years but no prospective association from age nine to 15 when a sub-sample was analysed.18

Furthermore, more of those who participated in organised PA wore the accelerometers for at least 3 days. Since there were sig-nificant differences between adolescents wearing and not wearing accelerometers, there might have been an overestimation regarding

F I G U R E 4   Total PA each day of the week among those who did/did not participate in organised PA and whose parents had low/high education levels. Adjusted for sex, age group, country of birth and type of municipality (presented as mean with 95% CI)

250 300 350 400 450 500 550

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Tota

l PA (counts per minutes)

Participated (low parental education) Participated (high parental education) Did not participate (low parental education) Did not participate (high parental education)

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FRÖBERG Etal.

absolute PA level and thus the number of adolescents reaching the PA recommendations. However, differences between organised and non-organised adolescents regarding PA level might have been less affected by this.

Finally, accelerometers have inherent limitations including an in-ability to adequately measure PA such as cycling (as they were worn on the hip by the participants of this study) and water-based activities such as swimming. Also, accelerometers might be deemed less feasi-ble to wear during contact sports due to, for example, safety concerns.

5 | CONCLUSION

The study showed that adolescents who participated in organised PA were more physically active, less sedentary and more likely to reach PA recommendations than those who did not participate. The study results might contribute with background information when developing interventions to increase PA among adolescents. ACKNOWLEDGEMENTS

The authors thank the school staff and students who participated in this study. We also thank other research team members who as-sisted with the data collection.

CONFLIC T OF INTEREST

The authors declare no conflicts of interest. ORCID

Andreas Fröberg https://orcid.org/0000-0002-3352-6661

Gisela Nyberg https://orcid.org/0000-0003-0004-8533

REFERENCES

1. Poitras VJ, Gray CE, Borghese MM, et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(Suppl 6):197-239.

2. Cliff DP, Hesketh KD, Vella SA, et al. Objectively measured sed-entary behaviour and health and development in children and adolescents: systematic review and meta-analysis. Obes Rev. 2016;17:330-344.

3. Cooper AR, Goodman A, Page AS, et al. Objectively measured physical activity and sedentary time in youth: the International children's accelerometry database (ICAD). Int J Behav Nutr Phys Act. 2015;12:113.

4. Nyberg G, Kjellenberg K, Fröberg A, Lindroos A-K. A national sur-vey showed low levels of physical activity in a representative sam-ple of Swedish adolescents. (unpublished manuscript).

5. LeBlanc AG, Katzmarzyk PT, Barreira TV, et al. Correlates of total sedentary time and screen time in 9–11 year-old children around the world: the international study of childhood obesity, lifestyle and the environment. PLoS ONE. 2015;10(6):e0129622.

6. Dumith SC, Gigante DP, Domingues MR, Kohl HW. Physical activity change during adolescence: a systematic review and a pooled anal-ysis. Int J Epidemiol. 2011;40:685-698.

7. Ortega FB, Konstabel K, Pasquali E, et al. Objectively measured physical activity and sedentary time during childhood, adolescence and young adulthood: a cohort study. PLoS ONE. 2013;8(4):e60871.

8. Ortega FB, Ruiz JR, Sjostrom M. Physical activity, overweight and central adiposity in Swedish children and adolescents: the European Youth Heart Study. Int J Behav Nutr Phys Act. 2007;4:61.

9. Metcalf B, Henley W, Wilkin T. Effectiveness of intervention on physical activity of children: systematic review and meta-analysis of controlled trials with objectively measured outcomes (EarlyBird 54). BMJ. 2012;345:e5888-e5888.

10. Love R, Adams J, Sluijs EMF. Are school-based physical activity interventions effective and equitable? A meta-analysis of cluster randomized controlled trials with accelerometer-assessed activity. Obes Rev. 2019;20(6):859-870.

11. Borde R, Smith JJ, Sutherland R, Nathan N, Lubans DR. Methodological considerations and impact of school-based inter-ventions on objectively measured physical activity in adolescents: a systematic review and meta-analysis. Obes Rev. 2017;18:476-490. 12. Brown HE, Atkin AJ, Panter J, Wong G, Chinapaw MJ, van Sluijs

EMF. Family-based interventions to increase physical activity in children: a systematic review, meta-analysis and realist synthesis. Obes Rev. 2016;17:345-360.

13. Nyström CD, Larsson C, Ehrenblad B, et al. Results from Sweden’s 2016 report card on physical activity for children and youth. J Phys Act Health. 2016;13:S284-S290.

14. Khan KM, Thompson AM, Blair SN, et al. Sport and exercise as con-tributors to the health of nations. Lancet. 2012;380:59-64. 15. Nelson TF, Stovitz SD, Thomas M, LaVoi NM, Bauer KW,

Neumark-Sztainer D. Do youth sports prevent pediatric obesity? A systematic review and commentary. Curr Sports Med Rep. 2011;10(6):360-370. 16. Lee JE, Pope Z, Gao Z. The role of youth sports in promoting chil-dren's physical activity and preventing pediatric obesity: a system-atic review. Behav Med. 2018;44:62-76.

17. Hebert JJ, Møller NC, Andersen LB, Wedderkopp N. Organized sport participation is associated with higher levels of overall health-related physical activity in children (CHAMPS Study-DK). PLoS ONE. 2015;10(8):e0134621.

18. Dalene KE, Anderssen SA, Andersen LB, et al. Cross-sectional and prospective associations between sleep, screen time, active school travel, sports/exercise participation and physical activity in children and adolescents. BMC Public Health. 2018;18(1):705.

19. Marques A, Ekelund U, Sardinha LB. Associations between orga-nized sports participation and objectively measured physical ac-tivity, sedentary time and weight status in youth. J Sci Med Sport. 2016;19:154-157.

20. Moraeus L, Lemming EW, Hursti UK, Arnemo M, Sipinen JP, Lindroos AK. Riksmaten adolescents 2016–17: a national dietary survey in Sweden – design, methods, and participation. Food Nutr Res. 2018;62:1-10.

21. Evenson KR, Catellier DJ, Gill K, Ondrak KS, McMurray RG. Calibration of two objective measures of physical activity for chil-dren. J Sports Sci. 2008;26:1557-1565.

22. Trost SG, Loprinzi PD, Moore R, Pfeiffer KA. Comparison of accel-erometer cut points for predicting activity intensity in youth. Med Sci Sports Exerc. 2011;43:1360-1368.

23. Cole TJ, Lobstein T. Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes. 2012;7:284-294.

24. Eime R, Young J, Harvey J, Charity M, Payne W. A systematic re-view of the psychological and social benefits of participation in sport for children and adolescents: informing development of a conceptual model of health through sport. Int J Behav Nutr Phys Act. 2013;10(1):98.

25. Wilks DC, Sharp SJ, Ekelund U, et al. Objectively measured physical activity and fat mass in children: a bias-adjusted meta-analysis of prospective studies. PLoS ONE. 2011;6(2):e17205.

26. Kobes A, Kretschmer T, Timmerman G, Schreuder P. Interventions aimed at preventing and reducing overweight/

(11)

obesity among children and adolescents: a meta-synthesis. Obes Rev. 2018;19(8):1065-1079.

27. Stalsberg R, Pedersen AV. Effects of socioeconomic status on the physical activity in adolescents: a systematic review of the evi-dence. Scand J Med Sci Sports. 2010;20(3):368-383.

28. Somerset S, Hoare DJ. Barriers to voluntary participation in sport for children: a systematic review. BMC Pediatr. 2018;18(1):47. 29. Martins J, Marques A, Sarmento H, Carreiro da Costa F.

Adolescents’ perspectives on the barriers and facilitators of physi-cal activity: a systematic review of qualitative studies. Health Educ Res. 2015;30(5):742-755.

30. Jonsson L, Larsson C, Berg C, Korp P, Lindgren EC. What under-mines healthy habits with regard to physical activity and food?

Voices of adolescents in a disadvantaged community. Int J Qual Stud Heal. 2017;12(1):1333901.

How to cite this article: Fröberg A, Lindroos A-K, Ekblom Ö, Nyberg G. Organised physical activity during leisure time is associated with more objectively measured physical activity among Swedish adolescents. Acta Paediatr. 2020;00:1–10.

References

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